Low power seven-step two-lobe holmium laser enucleation of the prostate technique for surgical treatment of benign prostatic hyperplasia

  • Ke LIU ,
  • Fan ZHANG ,
  • Chun-lei XIAO ,
  • Hai-zhui XIA ,
  • Yi-chang HAO ,
  • Hai BI ,
  • Lei ZHAO ,
  • Yu-qing LIU ,
  • Jian LU ,
  • Lu-lin MA
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  • Department of Urology, Peking University Third Hospital, Beijing 100191, China

Received date: 2018-03-16

  Online published: 2019-12-19

Supported by

Supported by the Key Program on Clinical Subject of Peking University Third Hospital(BYSY2016020)

Abstract

Objective: To evaluate the safety and efficacy of the seven-step two-lobe holmium laser enucleation of the prostate (HoLEP) technique with low power laser device, and to introduce the detailed operating procedures, key points, short-term outcomes of this modified HoLEP technique.Methods: From March 2016 to November 2017, 90 patients underwent HoLEP in Peking University Third Hospital. The patients were divided into two groups: high-power group (32 patients) were performed with tradi-tional Gilling’s three-lobe enucleation using high power (90 W) laser; Low-power group (58 patients) were performed with seven-step two-lobe enucleation using low power (40 W) laser. The main steps of the low power seven-step two-lobe HoLEP phase included: (1) The identification of the correct plane between adenoma and capsule at 5 and 7 o’clock laterally to the veru montanum; (2) The connection of the bila-teral plane by making a adenoma incision at the proximal point of veru montanum; (3) The extension of the dorsal plane under the whole three lobes between adenoma and capsule towards the bladder neck; (4) The separation of the middle lobe from two lateral lobes by making two retrograde incisions separately from apex 5 and 7 o’clock towards the bladder neck; (5) The enucleation of the middle lobe adenoma by extending the dorsal plane through into the bladder; (6) The prevention of the apex mucosa by making a circle incision at the apex of the prostate; (7) The en-bloc enucleation of the two lateral lobe adenomas by extending the lateral and ventral plane between adenoma and capsule from 5 and 7 o’clock to 12 o’clock conjunction and through into the bladder.Results: The mean patient age was (66.25±5.37) years vs. (68.00±5.18) years; The mean body mass indexes were (24.13±4.06) kg/m 2 vs. (24.57±3.50) kg/m 2; The mean prostate specific antigen values were (3.23±2.47) μg/L vs. (6.00±6.09) μg/L; The average prostatic volumes evaluated by ultrasound was (49.03±20.63) mL vs. (67.55±36.97) mL. There was no significant difference between the two groups. Furthermore, there were no significant differences in terms of perioperative and follow up data, including operative time; enucleation efficiencies; hemoglobin decrease; blood sodium and potassiumthe change postoperatively; catheterization duration and hospital stay; the international prostate symptom scores and quality of life scores pre- and post-operatively. There was 1 transurethral resection of the prostate (TURP) conversion in high-power group and 1 transfusion in low-power group during the operations. The follow-up one month after operation showed no severe stress incontinence in both the groups, whereas 3 cases ejacula-tory dysfunctions in high-power group versus 1 case in low-power group were observed; Other surgery-related complications included: 2 cases postoperative hemorrhage (Clavien Ⅱ and Clavien Ⅲb) in high-power group, 2 cases postoperative temperature more than 38 ℃ (Clavien Ⅰ) and 1 case dysuria following catheter removal (Clavien Ⅰ) in low-power group.Conclusion: Low power laser device can be applied safe and effectively for HoLEP procedure using the seven-step two-lobe HoLEP technique. The outcomes comparable with high power laser HoLEP can be achieved.

Cite this article

Ke LIU , Fan ZHANG , Chun-lei XIAO , Hai-zhui XIA , Yi-chang HAO , Hai BI , Lei ZHAO , Yu-qing LIU , Jian LU , Lu-lin MA . Low power seven-step two-lobe holmium laser enucleation of the prostate technique for surgical treatment of benign prostatic hyperplasia[J]. Journal of Peking University(Health Sciences), 2019 , 51(6) : 1159 -1164 . DOI: 10.19723/j.issn.1671-167X.2019.06.032

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